妊娠期高血压产妇中孕期胎儿腹内段脐动脉频谱多普勒动态变化规律及与妊娠结局的关系

目的 探讨妊娠期高血压(HDCP)产妇中孕期胎儿腹内段脐动脉频谱多普勒动态变化规律及与妊娠结局的关系。方法 回顾性分析2018年2月-2022年2月在本院行孕期检查及分娩的HDCP产妇150例 ,根据HDCP诊断标准将孕妇分为子痫前期组(54例)和单纯高血压组(96例),并选取同期50例健康产妇作为对照组。收集入组孕产妇妊娠中期(22~28周)胎儿多普勒超声血流成像检查结果,比较各组间胎儿脐动脉血流相关参数动脉搏动指数(PI)、阻力指数(RI)以及血流速度峰谷比(S/D)]和不良妊娠结局情况。应用Pearson相关分析法分析脐动脉血流相关参数与HDCP疾病程度的相关性。绘制受试者工作特征(ROC)曲线分析脐动脉血流相关参数预测不良妊娠结局的价值。结果 子痫前期组和单纯高血压组PI、RI、S/D值均高于对照组(P<0.05)。子痫前期组PI、RI、S/D值高于单纯高血压组(P<0.05)。孕中期脐动脉PI、RI、S/D均与HDCP疾病程度呈正相关(r=0.268, 0.226, 0.350, 0.672,P_均<0.05)。子痫前期组和单纯高血压组总不良妊娠结局率均高于对照组(51.85% vs 12.00%,28.72% vs 12.00%,P_均<0.05)；子痫前期组总不良妊娠结局率高于单纯高血压组(51.85% vs 28.72%,P<0.05)。HDCP妊娠结局不良者PI、RI、S/D值均高于妊娠结局良好者(P<0.05)；HDCP孕中期PI、RI、S/D均对不良妊娠结局均具有预测价值(AUC=0.736, 0.816, 0.808, 0.800,P_均<0.05)。结论 HDCP孕中期PI、RI、S/D等脐动脉血流参数有明显上升趋势,且随着疾病程度的恶性发展升高；不良妊娠结局者孕中期PI、RI、S/D和Qdv/Quv等脐动脉血流参数升高,可作为预测HDCP不良妊娠结局的指标。

Dynamic change rules of umbilical artery Doppler spectrum in fetal abdomen and its relationship with pregnancy outcomes of puerperae with hypertensive disorder complicating pregnancy

Objective To explore dynamic change rules of umbilical artery Doppler spectrum in fetal abdomen and its relationship with pregnancy outcomes of puerperae with hypertensive disorder complicating pregnancy (HDCP). Methods A total of 150 puerperae with HDCP undergoing pregnancy examination and delivery in the hospital were retrospectively analyzed between FebruaryS2018 and February 2022. According to diagnostic criteria of HDCP, they were divided into preeclampsia group (54 cases) and simple hypertension group (96 cases). A total of 50 healthy puerperae during the same period were enrolled as control group. The results of fetal Doppler ultrasound blood flow imaging in the second trimester (22-28 weeks) were collected. The blood flow related parameters of fetal umbilical artery arterial pulsatility index (PI), resistance index (RI), peak-to-valley ratio of flow velocity (S/D)] and adverse pregnancy outcomes in different groups were compared. The correlation between umbilical artery blood flow-related parameters and the severity of HDCP was analyzed by Pearson correlation analysis. The predictive value of umbilical artery blood flow-related parameters for adverse pregnancy outcomes was analyzed by receiver operating characteristic (ROC) curves. Results PI, RI and S/D were the greatest in preeclampsia group, followed by simple hypertension group and control group (P<0.05). PI, RI and S/D of umbilical artery in the second trimester were all positively correlated with the severity of HDCP (r=0.268, 0.226, 0.350, 0.672, P<0.05). The overall incidence of adverse pregnancy outcomes in preeclampsia group and simple hypertension group was higher than that in control group (51.85% vs 12.00%, 28.72% vs 12.00%, P<0.05). The overall incidence of adverse pregnancy outcomes in preeclampsia group was higher than that in simple hypertension group (51.85% vs 28.72%, P<0.05). PI, RI and S/D in HDCP patients with adverse pregnancy outcomes were greater than those with good pregnancy outcomes (P<0.05). PI, RI and S/D in the second trimester were of predictive value for adverse pregnancy outcomes (AUC=0.736, 0.816, 0.808, 0.800, P<0.05). Conclusion The umbilical artery blood flow parameters (PI, RI, S/D) significant increase in the second trimester of HDCP, which increase with the malignant development of the disease. The umbilical artery blood flow parameters (PI, RI, S/D) increase in HDCP patients with adverse pregnancy outcomes in the second trimester, which can be applied as predictive indexes for adverse pregnancy outcomes.